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Background: More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important., Objectives: To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy., Search Methods: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016., Selection Criteria: Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy., Data Collection and Analysis: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score., Main Results: No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016., Authors' Conclusions: The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.

Background: The carbon dioxide laser can induce thermal cytologic artifacts at the margin of early glottic squamous cell carcinoma histologic specimens, which makes assessment of the margin difficult. This study assesses and correlates the depth of laser-induced thermal artifact with laser power rating., Methods: The surgical margins of 30 patients with early glottic squamous cell carcinomas who underwent laser resection were reanalyzed retrospectively., Results: Thermal damage consisted of collagen denaturation within the vocal cord lamina propria and vocalis muscle, and epithelial structural changes. There was a decrease in depth of tissue artifact with increased power rating (p > .05). The average depth of thermal damage was 380.83 ± 178.79 μm., Conclusion: The laser causes less thermal damage at higher power, presumably because of the increased speed of cutting and reduced contact time with surrounding cells. Knowledge of the depth of thermal artifact is important surgically when ensuring the cancer is excised with sufficient oncologic margin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E712-E716, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: Transoral laser microsurgery (TLM) of the glottis is increasingly utilized in the current management of early glottic cancer, its advantages being administrative ease, potential to be repeated, ability to keep radiotherapy and open laryngeal surgery available as salvage options, and low complication rates., Methods: A retrospective chart review of prospectively gathered data on all patients over a 10-year period who had undergone TLM for Tis or early (T1-2) glottic squamous cell carcinomas (SCCs) was analyzed to examine the complications experienced., Results: Of 132 patients undergoing TLM, complications were: edema requiring tracheostomy (n = 1), surgical emphysema (n = 1), pharyngeal bruising (n = 1), endotracheal tube cuff perforation (n = 1), anterior glottic web (n = 14), vocal cord granuloma (n = 14), laryngocele (n = 1), and none of airway fire or intraoperative or postoperative hemorrhage., Conclusion: Our results suggest that for early glottic cancers, and in skilled hands, with appropriate anesthetic and theater staff support, TLM is a safe and repeatable procedure. © 2015 Wiley Periodicals, Inc. Head Neck 38: E987-E990, 2016., (© 2015 Wiley Periodicals, Inc.)

Objectives/hypotheses: This study proposed the use of signal typing and acoustic measures experimentally validated for aperiodic voices to investigate voice outcomes after transoral laser microsurgery (TLM) for early glottic carcinoma. It was of interest whether signal type and pitch-tracking indicators would reveal unreliable perturbation and noise measures. As an alternative, smoothed cepstral peak prominence (CPPS) was used for the first time in this population., Study Design: A descriptive study of patients treated with TLM for early glottic carcinoma., Methods: All participants (n=14) performed a series of vocal tasks. Narrowband spectrograms were generated from voice recordings and classified into one of four signal types. The perturbation and noise measures of periodic or near-periodic signals only were reported. The CPPS for sustained vowel (CPPS-/a/) and connected speech (CPPS-s) were calculated for all participants. The relationship between voice outcomes and tumor and TLM factors was investigated., Results: Nine of 14 participants had an aperiodic type 3 signal. Three of 14 participants had voices considered reliable for perturbation analysis. Absolute jitter, %jitter, %shimmer, and signal-to-noise ratio were all low; however, CPPS-/a/ and CPPS-s amplitudes were below the normal range for most participants. Involvement of the anterior commissure, number of TLM episodes, and time post-surgery were associated with worse voice outcomes. There were strong correlations between signal type, CPPS-/a/, and pitch-tracking indicators., Conclusions: The limitations of perturbation analysis should be considered when analyzing the voice after TLM. Signal type should be considered before conducting perturbation analysis. The CPPS-/a/ and CPPS-s may be more reliable acoustic outcome measures for this population., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Early laryngeal carcinomas may be treated by transoral laser microsurgery (TLM) or external beam radiotherapy. We review our experience of surgical treatment of laryngeal pre-malignant and malignant lesions over the past 15 years in a high-volume head neck unit. Methods: A review of a prospective patient database of patients with laryngeal SCC, who were treated with CO2 TLM between 2004 and 2019 was carried out. Results: 83 patients with a mean age of 67.7 (SD: 10.6) years underwent primary curative TLM for T1a/b SCC. 5-year overall survival was 93.2% (95%CI 86.9–100%), disease free survival was 86.0% (95%CI 78.1–94.6%), locoregional control was 91.2% (95%CI: 85.1–97.7%) and larynx preservation rate of 95.1% at 5 years. Conclusion: TLM is an excellent treatment modality for T1 early glottic SCC, with excellent locoregional control and disease-free survival. It is minimally invasive, outpatient-based, and cost-effective procedure preserving upper aerodigestive tract dysfunction for all activities of daily living. [ABSTRACT FROM AUTHOR]